jurnal sol meningioma

8/10/2019 Jurnal SOL Meningioma

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ningiomas:

G uide for Nurses and Other Heal th Care Professionals

derstanding these brain and spinal tumors while promoting opt imum care for y our patients.

Nancy Conn-Levin, M. A.

dical advisor: Peter McLaren Black, M.D., Ph.D.

ny nurses, phy sical therapists, occ upational therapists and other members of the medical team have little knowledge about

ningiomas, t he most common variety of primary brain tumor. A ccording to the Central Brain Tumor Registry of the United St atesBTRUS), meningiomas comprise over 27% of primary brain tumors, those that originate in the cent ral nervous system. M eningiomas

the only variety of central nervous system tumor that is more common in women than in men (by at least a 2:1 ratio). A lthough

se tumors are more common in midlife, they can affect people at any age. W hile the majority of meningiomas are histologically

egoriz ed as benign, that term is certainly misleading. Unlike benign tumors elsewhere in the body , benign intracranial tumors can

use severe brain injuries and death. Epidemiological studies indicate that benign meningiomas have an estimat ed five-year survival

e of 70%, a rate that is lower than the comparable five-year survival for breast cancer. Even after successful treatment, meningiomas

en reoccur and may cause grave neurological deficits. Like other varieties of brain tumors, meningiomas occur in healthy people

hout any risk factors. There is no way t o prevent these tumors or predict who will develop them.

the present t ime, the inc idence rate of meningiomas in the United St ates can only be estimated because mandatory report ing of all

in tumors has not been instituted. On Oc tober 29, 2002, the Benign Brain Tumor Cancer Registries Amendment A ct became a law,

uiring that individual state cancer registries collect data about all varieties of primary brain tumors. Several years will be needed to

ect and analyz e enough data to determine comprehensive statistics. M eanwhile, estimates have been constructed using data from

se states that have been collect ing benign brain tumor information. Even from these limited numbers, it is c lear that meningiomas

sent a significant threat to life and health.

agnosis and Commo n Presentations

ial diagnosis of a meningioma may be challenging. Because these tumors arise from the meninges, the delicate membrane that

vers the entire brain and spinal cord, meningiomas can present with numerous symptoms. In many cases, meningiomas appear to

w slowly, which allows the adjacent brain tissue to gradually adapt to compression. W hen this slower growth occurs, some

ningiomas can expand to be significantly large lesions (>5 cm.) and yet remain asy mptomatic. W ith the increased availability of MRI

ans and other diagnostic imagery techniques, a greater number of meningiomas are now diagnosed as incidental findings. If those

ningiomas remain asymptomatic and do not present an immediate threat to life or health, they may be monitored with annual (or

re frequent) follow up scans. In contrast, other meningiomas are diagnosed from imaging studies performed to identify the source ofzures, headaches, visual changes or other manifestations.

ningiomas can produce sy mptoms in different ways, including compression of t he brain or cranial nerves, vascular injuries or irritation

he cortex t hat can lead to seiz ure act ivity . In some cases, the location of the tumor may be associated with specific neurological

mptoms. However similar sy mptoms may result from other conditions and are not necessarily associated with any brain tumors.

ec tive neuroimaging is an essential part of any different ial diagnosis for meningiomas and other intracranial tumors. In most cases,

RI scans with contrast provide the diagnostic information needed. W hen MRI scans are contraindicated or when hyperostosis occurs,

scans may also be useful.

mong the frequent sy mptoms that may be caused by meningiomas are seiz ures, headac hes, muscle weakness, confusion, changes

personality , and visual disorders. Because other diseases can cause similar sy mptoms, misdiagnosis is common prior to

ntification of the t umor through diagnostic imaging. Unfortunately , particularly among mid-life women (who are stat istically most likely

develop these tumors), vague symptoms may be ascribed to menopause or to illnesses such as endocrine disorders, depression, or

oimmune disorders.

some cases, t he association between specific sy mptoms and a meningioma may not be c lear until after the t umor has been

gically removed. If symptoms disappear after t reatment, t heir connection to t he tumor may be implied. Nurses who are familiar with

ssible meningioma sy mptoms, t he importance of diagnostic imaging when a meningioma is suspected, and appropriate t reatment

ions can provide an important link in patient education about these tumors.


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oosing Treatment Options

termining the optimal treatment for a meningioma depends on several fact ors. These include:

ients age

erall health

siz e of the meningioma (certain t y pes of focused radiation treatments can only be utiliz ed for smaller tumors)

ningioma location (regarding both surgical access to the tumor, and potential damage to adjacent cranial nerves or other critical

as of the brain)

availability of neurosurgical and radiation therapy services near the pat ients home

patients ability to t ravel to a specialized brain tumor center

patients personal preference for treatment

ningiomas and their t reatments may lead to neurological deficits t hat require rehabilitation. In some cases, a pat ient is well enough

go home after treatment, but st ill needs assistance with act ivities of daily living. It is important to review your patient s living

angements and family situat ion to determine if additional home health care or other kinds of support may be needed.

urosurgery and Pathology

nventional neurosurgery is an effect ive treatment for most meningiomas. For selected cases, neurosurgery can be performed using

nimally invasive procedures. These include image guided surgery , t ranssphenoidal surgery and endoscopic procedures. Image

ded surgery is available in many medical cent ers, including some which offer intraoperat ive M RI units. This technology allows the

urosurgeon to accurately navigate during complex intracranial procedures; the t umor can be precisely localized. Depending on the

mplexity of the surgical procedure, t he patients state of health and any potential complications, it is often possible to t reat

ningiomas during a short period of hospitaliz ation (2 to 4 days). In other cases, meningioma surgery may be followed by

abilitation in a specialized facility . Overall, surgery offers the best initial therapy for most meningiomas. It is important, however, that

e done in a center that has a complete understanding of these tumors.

hological ex amination of meningiomas can provide information that may be helpful in planning further treatment. This includes

ntifying histological classificat ion by subgroup, the presence or absence of hormone receptors, and grade of malignancy . A lthough

st of these tumors are classified as benign, some are identified as aty pical or malignant meningiomas. W hen benign meningiomas

ccur after t reatment, they may develop as higher-grade tumors. A ty pical and malignant meningiomas are characteriz ed as having an

reased rate of growth and higher likelihood of recurrence when compared with benign meningiomas. M eningiomas do not usually

tastasize outside of the nervous system. In ext remely rare cases, meningiomas can metastasiz e (most commonly to the lung).

en within the confines of the brain and spinal cord, malignant meningiomas may be especially resistant to t reatment. Because of the

eat of recurrent growth of any variety of meningioma, follow up MRI and/or CT scans are an integral part of the lifelong health care for

sons who have been diagnosed with these tumors.

pat ient s posit ive ex pectations about surgery and faith in his or her surgical team can promote an optimal postoperat ive recovery .

hether patients are anx ious about impending neurosurgery or confident of a hopeful outcome, nurses and other members of the

dical team can encourage their pat ients to ask questions and to freely discuss their feelings about meningioma treatment.

diation, Chemotherapy, and Observation

diation therapy (RT) may be used as an adjunctive treatment for meningiomas. It is also used as treat ment for recurrent

ningiomas, especially when repeated craniotomies present significant risks. Certain ty pes of focused radiotherapy are known by t he

mes of the medical systems used for these procedures. LINAC radiation or Gamma Knife (GK) are ex amples of treatments which

zes a single episode of focused radiation. Other ty pes of focused radiotherapy include IMRT (intensity modulated radiation therapy),

ct ionated Stereotact ic Radiosurgery (FSR, a series of smaller doses of concentrated radiation) and Proton Beam (heavy particle

iation therapy).

emotherapy has been used for individual recurrent meningiomas, but it is less commonly administered to treat these tumors as

mpared to other varieties of brain tumors. It does not offer significant help at present. Several clinical trials are underway which may

ntify effect ive agents t hat could be more widely utilized as a t reatment option for meningiomas.

hen small meningiomas are asy mptomatic, patients may be advised to pursue sequential imaging studies as a short or long-term

proach. If an asy mptomatic meningioma does not appear to be growing, t his watch and wait t echnique may eliminate the risks from

urosurgery or radiation t reatments. This option may also be used in elderly patients and those with chronic diseases who are not

ndidates for immediate intervention. In all cases, the potential risks and benefits for any ty pe of meningioma treatment must be

aluated on an individual basis.

eatment Risks and

low-up Care


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acranial neurosurgery presents risks of cerebral edema, bleeding and infection. Rat es of perisurgical morbidity and mortalit y vary

ong different neurosurgeons and various hospitals. Post operative nursing care, bot h in hospital and through visiting nurse services

er discharge can help identify early signs of complications during the healing process. Particularly in the 24-hour period immediately

owing intrac ranial surgery , evaluations of neurological status can provide useful information leading to early intervent ion if

mplications occur. Even after recuperation from neurosurgery, changes in patients neurological status are important to monitor.

me possible signs of acquired brain injury include:

ort term memory loss

hasia or other speech disorders

persensitivity to light, sound, t ouch

stibular disorders

ention and concentration difficultyanges in behavior or emotional functioning

sources are available to help patients with mild to moderate brain injury. It is important to encourage your pat ients to pursue whatever

e of rehabilitat ion services that may be helpful to their recovery .

ychosocial Effects of Men ingiomas and Treatment

e experience of being diagnosed with a brain tumor can profoundly alter an individuals sense of self. Espec ially for men and women

o have been previously healthy, confronting a potentially life threatening condition can be emotionally traumatic. Individual counseling,

up psychotherapy and creative arts therapies (i.e., dance therapy , music therapy, art therapy, etc. ) can be important ways for

ients to ex press their emotional react ions to t his life changing experience. Many patients benefit from brain tumor support groups,

ere they can meet others who have similar concerns and share their feelings with one another. Online brain tumor support groupser an alternative resource for people who are confined to home, or who do not live close to an area where conventional brain tumor

pport groups are located. Online support is available 24 hours a day , seven days a week, and this constant access to

mmunication can be very comforting.

mily members and friends of meningioma patients may have difficulty coping with this illness. M isunderstandings about the serious

ure of these tumors are common. People may avoid offering needed support, thinking that t his benign tumor is not serious. Nurses

d other health c are professionals can help educate family members or other concerned individuals about these common my ths:

Y TH: Benign brain tumors are not serious.

CT: A ny brain tumor can have potentially serious complications.

Y TH: M eningiomas can be cured by surgical removal.

CT: W hile complete surgical ex cision can promote a long period of remission, recurrent tumors are still a threat. Long-term follow up

mportant.

Y TH: Large meningiomas cause more damage than small meningiomas.

CT: M any t hings (including the location of the tumor) affect t he amount of neurological damage associated with a meningioma. A

ge tumor may be asymptomatic while a tiny meningioma in a delicate area (such as adjacent to the optic nerve) may c ause

manent neurological damage.

Y TH: Follow up care is only needed for a short time after treatment.

CT: Recurrent meningiomas can develop years and even decades after an initial tumor. A nyone with a history of meningioma should

eive regular follow up diagnostic imaging as part of his or her lifelong health care.

Y TH: M eningiomas can be prevented.

CT: A lthough brain tumors of any variety cannot be prevented, early detection through diagnostic imaging can identify new or

urrent t umors at a smaller size. In some cases, this allows for additional ty pes of treatment options to be considered.

oviding Information and Support to Pa tients

oughout the continuum of meningioma diagnosis, treatment and recuperation, nurses, therapists, and other members of the medical

m can have an act ive role in educat ing patients while providing encouragement and compassion. In addition to different ty pes of

vidual or group therapy , online and in-person support groups, the following resources can also be useful to your patients:

aritable organizat ions that provide free materials and services to brain tumor patients and family members

ucational publications about brain tumors

ient advocates

in tumor conferences and events


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u can help patients adjust to a meningioma diagnosis by encouraging them to be proactive about t hem own health care. Get ting a

cond opinion or even two or three additional opinions about t reatment options may be indicated in challenging cases. M aking a

cision about neurosurgery, radiation therapy or other meningioma treatments is not an easy c hoice. Providing reassurance to y our

ients and helping them find additional guidance can be especially meaningful. A fter t reatment, y ou can promote increased quality of

for your patients by helping to develop plans for their follow up care, inc luding assessment of the need for various ty pes of

abilitation services.

til the time when meningiomas can be prevented, pat ients with this diagnosis will confront t he ever-present possibility of recurrent

mor growth and the need for additional treatment. A djusting to this diagnosis as a chronic concern means that patients must be

ponsible for gett ing future follow up diagnostic scans, and for being aware of neurological symptoms that might indicat e a recurrent

ningioma. Early detect ion of any meningioma allows the best probability for successful treatment and recovery. W ith appropriate

pport from y ou and other members of their medical team, meningioma patients can be encouraged to live each day fully to the best of

ir ability .COMMENDED READING

Primer of Brain Tumors: A Patient s Reference M anual(25th anniversary edition), A merican Brain Tumor Association, Des Plaines, IL

lor Me Hope: A Resource Guide for People Affected by Brain Tumors , The Brain Tumor Society, Watertown, MA

agami R, Napolit ano M , Sekhar LN, Pat ient-evaluat ed outcome after surgery for basal meningiomas, Neurosurgery. 50(5):941-8;

cussion 948-9. M ay 2002.

ster, BD, K oepsell TD, M ueller BA , The association between breast carcinoma and meningioma in women, Cancer. 94(6):1626-35.

rch 2002.

kanis SN, Quinones-Hinojosa A, Buz ney E, Ribaudo HJ, Black PM , Quality of life following surgery for intracranial meningioma at

gham & W omens Hosptial: a study of 164 patients using a modification of the funct ional assessment of cancer t herapy -brain

estionnaire, Journal of Neuro-oncology. 48(3):233-41. July 2000.

minski JM, M ovsas B, K ing E, Y ang c, Kronz JD, A lli PM, W illiams J, Brem H, Metastatic meningioma to the lung with multiple

ural metastases, Americ an Journal of Clinic al Oncology. 24(6):579-82. December 2001.

vine Zt, Buchanan RI, Sekhar LN, Rosen CL, W right DC, Proposed grading system to predict the ext ent of resect ion and outcomes

cranial base meningiomas, Neurosurgery. 45(2):221-30. A ugust 1999.

Carthy, BJ, Davis, F , F reels, S, Surawicz , T, Damek, D, Grutsch, J, M enck, H, Laws, E, 'Factors associated with survival in patients

h meningioma," Journal of Neurosurgery. 88:831-839, May 1998.

erdling T, Dothage J, Meningiomas in children and adolescents, Journal of Pediatric Hemotology/Oncology. 24(3):199-204.

rch-A pril 2002.

ncy Conn-Levin, M. A ., Health Educator, is a brain tumor survivor who provides support and information to others affected by t hese

mors. She is a member of the Advisory Board of the Brain Science Foundation and serves as a Director of The Healing Ex change

A IN TRUST. She facilitat es The M eningioma List, an online support group

ter McL. Black, M.D, Ph.D. , M edical A dvisor, is Neurosurgeon-in-Chief, Brigham and W omens Hospital and Childrens Hospital,

ston, M A , Chief of Neurosurgical Oncology, Dana Farber Cancer Institute, B oston, M A , and Franc D. Ingraham Professor of

urosurgery, Harvard M edical School.

knowledgments

nding for the development and distribution of this booklet and other educational materials has been contributed by The Brain Sc ience

undation.

p://www.brainsciencefoundation.org

pyright 2003 by Nancy Conn-Levin, M .A . A ll rights reserved.

dit ional copies of this book let are available by contacting:

mmunications Coordinator

partment of Neurosurgery

gham & W omen's Hospital
http://www.brainsciencefoundation.org/http://www.brainsciencefoundation.org/


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Francis Street

ston, MA 02115

r more information about brain tumors, contact these charitable organiza tions :

erican B rain Tu mor Association

20 River Road

s Plaines, IL 60018

l free: 800-886-2282

ce: 847- 827-9910

x : 847-827-9918

p://www.abta.org

ain Tumour Foundation of Canada

0 Colborne Street, Suite 301

ndon, ON N6B 3R9

nada

ce: 519-642-7725

x : 519- 642-7192http://www.braintumour.c a

e Brain Tumor Society

4 Watertown Street, Suite 3-H

tertown, MA 02472

l free: 800-770-8287ce: 617- 924-9997

x : 617-924-9998

p://www.tbts.org

ntral Brain Tumor Registry of the U.S .

33 West 47th Street

cago, IL 60632

ce: 630-655-4786

x : 630- 655-1756

p://www.cbtrus.org

e Healing Exchange BRAIN TRUST

.E. BRAIN TRUST

6 Hampshire Street

mbridge, MA 02139-1320

l free: 877-252-8480

ce: 617- 876-2002

x : 617- 876-2332http://www.braintrust.org

tional Brain Tumor Foundation

Battery St reet, S uite 612

n Francisco, CA 94111-5520

l free: 800-934-2873

ce: 415-834-9970

x : 415-834-9980p://www.braintumor.org

sclaimer

s booklet is an educational resource about meningiomas intended for use by nurses and other health care professionals. The text

not meant to be a substitute for medical care.

ephone numbers and other contact information for organizations listed above may be subject to change.

line Support and Information

e online groups are provided by The Healing Ex change BRA IN TRUST, a charitable organiz ation that helps people affected by brain

mors and related condit ions. M ore than two thousand brain tumor survivors, family members and others who are interested in this

ic exchange email messages, sharing support and information with each other. To learn about the BRA INTMR list, The Meningioma

t, TOPS (teens of parent survivors) or other online groups, contact:

[email protected]

dit ional informat ion about most of these groups is also available at this web site:
http://www.abta.org/http://www.braintumour/http://www.tbts.org/http://www.cbtrus.org/http://www.braintrust.org/http://www.braintumor.org/mailto:[email protected]:[email protected]://www.braintumor.org/http://www.braintrust.org/http://www.cbtrus.org/http://www.tbts.org/http://www.braintumour/http://www.abta.org/


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p://www.braintrust.org/services/support/
http://www.braintrust.org/services/support/http://www.braintrust.org/services/support/

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